Comprehensive Cleft Care Project Harar is a proud member of the Circle of Cleft Professionals, committed to providing, promoting and practicing comprehensive cleft care. What is Comprehensive Cleft Care? Comprehensive cleft care addresses the notion that cleft care should aim to factor in the life-long care required by patients affected by cleft lip and palate. Cleft care should be fully inclusive to all no-matter of age, gender, race or socio-economic background and also should include care for a patients physical and social needs before and after surgery. Our Programme By being a part of the Circle of Cleft Professionals, Project Harar contribute to discussions with other cleft NGO's and cleft professionals around the world to share learnings from our programme and ideas for improvement and expansion, many of these NGO's also operate in similar challenging health environments in developing countries. We practice a sustainable attitude to providing access to cleft care, once patients are identified they are referred to local surgeons in hospitals in country, who have been trained by Smile Train. Over the years, we have developed an extensive outreach programme that spans across the most rural and remote areas of Ethiopia, the programme caters to the health system in Ethiopia's use of Health Extension Workers (HEW's), individuals who travel out to hard to reach, far away communities that cannot easily reach a health clinic/institution. Project Harar Programme Officers work hard with HEW's to identify and monitor new cleft cases in rural areas and provide support to patients and their families before, after and during treatment. Project Harar Programme Officers provide regular training seminars to support and educate HEW's in identifying patients with cleft so they can be referred to Project Harar at the correct stage to receive treatment and also to pass important information to mothers on feeding/breastfeeding a baby with cleft. - - Stigma against those born with cleft in rural Ethiopia is extremely prevalent, it is common for families to hide their baby away and more often than not, the child will not attend school until they have received treatment. Programme Officers integrate positive health messaging against cleft stigma within their HEW training. In 2019 we established a mothers support group to help mothers share the l psychological and physical effects of raising a child born with cleft. Project Harar recognise that in rural communities in Ethiopia religious and community leaders have a huge impact on health messaging being disseminated, which is why Programme Officers also offer the same training seminars and workshops to these figure heads. Inadequate food intake, disease, food insecurity and poor sanitation in rural Ethiopia can lead to an increased risk of malnutrition. A cleft lip and palate can exacerbate the risk of a child becoming malnourished because of the varied feeding challenges that having a cleft lip creates. Programme Officers also provide training to HEW's that centre around how to optimize nutrition before and after surgery for patients.